Nadia Aissaoui1,2,3, Etienne Puymirat2,4, Clément Delmas5, Sofia Ortuno1,2, Eric Durand6,7, Vincent Bataille5, Elodie Drouet6,7, Laurent Bonello8, Eric Bonnefoy-Cudraz9, Gilles Lesmeles10, Emmanuel Guerot1,2, Francois Schiele11, Tabassome Simon6,12,13,14, Nicolas Danchin2,4,13. 1. Department of Critical Care, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Européen Georges Pompidou (HEGP), Paris, France. 2. Faculty of Medicine, University Paris Descartes, Paris, France. 3. INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France. 4. Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France. 5. Intensive Cardiac Care Unit, CHU Rangueil, Toulouse, France. 6. Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST-CRB-CRC), APHP-Sorbonne Université, Hôpital St Antoine, Paris, France. 7. Hôpital Charles Nicolle, Rouen, France. 8. CHU Hôpital Nord, Marseille, France. 9. CHU de Lyon, Université de Lyon 1, Lyon, France. 10. CHRU Lille, Lille, France. 11. CHU Besancon, France. 12. Unité INSERM U-1148, Paris, France. 13. FACT (French Alliance for Cardiovascular Trials), An F-CRIN Network, Paris, France. 14. Sorbonne-Université, UPMC, Paris, France.
Abstract
AIMS: Few studies describe recent changes in the prevalence, management, and outcomes of cardiogenic shock (CS) patients complicating acute myocardial infarction (AMI) in the era of widespread use of invasive strategies. The aim of the present study was to analyse trends observed in CS complicating AMI over the past 10 years, focusing on the timing of CS occurrence (i.e. primary CS, CS on admission vs. secondary CS, CS developed subsequently during hospitalization). METHODS AND RESULTS: Three nationwide French registries conducted and designed to evaluate AMI management and outcomes in 'real-life' practice included consecutive AMI patients (n = 9951) admitted to intensive cardiovascular care units (ICCUs) over a 1-month period, 5 years apart. The prevalence of CS complicating AMI decreased from 2005 to 2015: 5.9%, mean age 74.1 ± 12.7 in 2005; 4.0%, mean age 73.9 ± 12.7 in 2010, 2.8%, mean age 71.1 ± 15.0 in 2015 (P < 0.001). It decreased for both primary (1.8% to 1.0%) and secondary CS (4.1% to 1.8%). The profile of CS patients also changed over time with more patients presenting out-of-hospital cardiac arrest. In both primary and secondary CS, the use of percutaneous coronary intervention increased markedly over time, as did the use of mechanical ventilation and cardiac assist devices. Over the 10-year period, in-hospital mortality remained unchanged for both primary CS (41.8% to 37.8%) or secondary CS (57.3% to 58.8%). However, 1-year mortality decreased in patients with primary CS (from 60% to 37.8%, P = 0.038), and remained unchanged in patients developing secondary CS (from 64.5% to 69.1%, P = 0.731). CONCLUSION: Cardiogenic shock complicating AMI has become less frequent but, if present, CS, and particularly secondary CS, carries a very high mortality, which has not substantially improved over the past 10 years, in spite of the more frequent use of invasive strategies.
AIMS: Few studies describe recent changes in the prevalence, management, and outcomes of cardiogenic shock (CS) patients complicating acute myocardial infarction (AMI) in the era of widespread use of invasive strategies. The aim of the present study was to analyse trends observed in CS complicating AMI over the past 10 years, focusing on the timing of CS occurrence (i.e. primary CS, CS on admission vs. secondary CS, CS developed subsequently during hospitalization). METHODS AND RESULTS: Three nationwide French registries conducted and designed to evaluate AMI management and outcomes in 'real-life' practice included consecutive AMIpatients (n = 9951) admitted to intensive cardiovascular care units (ICCUs) over a 1-month period, 5 years apart. The prevalence of CS complicating AMI decreased from 2005 to 2015: 5.9%, mean age 74.1 ± 12.7 in 2005; 4.0%, mean age 73.9 ± 12.7 in 2010, 2.8%, mean age 71.1 ± 15.0 in 2015 (P < 0.001). It decreased for both primary (1.8% to 1.0%) and secondary CS (4.1% to 1.8%). The profile of CSpatients also changed over time with more patients presenting out-of-hospital cardiac arrest. In both primary and secondary CS, the use of percutaneous coronary intervention increased markedly over time, as did the use of mechanical ventilation and cardiac assist devices. Over the 10-year period, in-hospital mortality remained unchanged for both primary CS (41.8% to 37.8%) or secondary CS (57.3% to 58.8%). However, 1-year mortality decreased in patients with primary CS (from 60% to 37.8%, P = 0.038), and remained unchanged in patients developing secondary CS (from 64.5% to 69.1%, P = 0.731). CONCLUSION:Cardiogenic shock complicating AMI has become less frequent but, if present, CS, and particularly secondary CS, carries a very high mortality, which has not substantially improved over the past 10 years, in spite of the more frequent use of invasive strategies.
Authors: Benjamin Hibbert; Bram Rochwerg; Shannon M Fernando; Rebecca Mathew; Behnam Sadeghirad; Daniel Brodie; Emilie P Belley-Côté; Holger Thiele; Sean van Diepen; Eddy Fan; Pietro Di Santo; Trevor Simard; Juan J Russo; Alexandre Tran; Bruno Lévy; Alain Combes Journal: Can J Anaesth Date: 2022-10-04 Impact factor: 6.713
Authors: M D Lauridsen; J H Butt; L Østergaard; J E Møller; C Hassager; T Gerds; K Kragholm; M Phelps; M Schou; C Torp-Pedersen; G Gislason; L Køber; E L Fosbøl Journal: Int J Cardiol Heart Vasc Date: 2020-10-13
Authors: Benedikt Schrage; Uwe Zeymer; Gilles Montalescot; Stephan Windecker; Pranas Serpytis; Christiaan Vrints; Janina Stepinska; Stefano Savonitto; Keith G Oldroyd; Steffen Desch; Georg Fuernau; Kurt Huber; Marko Noc; Steffen Schneider; Taoufik Ouarrak; Stefan Blankenberg; Holger Thiele; Peter Clemmensen Journal: J Am Heart Assoc Date: 2021-10-08 Impact factor: 5.501